Provider Demographics
NPI:1144974635
Name:DEVINE, GRACE ALEXANDRA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ALEXANDRA
Last Name:DEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9157
Mailing Address - Country:US
Mailing Address - Phone:330-840-0799
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4219
Practice Address - Country:US
Practice Address - Phone:330-835-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant